A Call for a Transformative Public Health Training: The Necessity of Abolition

Abstract

The societal distrust of public health alongside the complex, intersecting, and large public health crises of today and our future requires a transformation of the education of the next generation of public health leaders. The field of public health’s goals of health equity for all cannot be advanced until our field interrogates and resists the prison industrial complex (PIC), which maintains White supremacy and (re)produces health inequities. As current and former public health students, we propose incorporating abolition of the PIC as a political vision, structural and power analysis, and organizing strategy into the public health curriculum. We highlight gaps in the public health curriculum and the existing similarities between stated goals of abolition and public health. We propose calls to action for individuals, faculty, and schools of public health to interrogate the carceral nature of public health and work toward contributing to the positive project of an abolitionist future.

Following the uprising against police violence after the state-sanctioned murders of George Floyd, Breonna Taylor, Walter Wallace, Tony McDade, and many others, public health departments, academic institutions, and the Centers for Disease Control and Prevention (CDC, 2021) finally declared racism a public health threat and core driver of health inequities. If the public health field aims to truly confront racism and meet its goals of advancing health equity for all, we must recognize the prison industrial complex (PIC), which is defined as the “overlapping interests of government and industry that use surveillance, policing, and imprisonment as solutions to economic, social and political problems” (Critical Resistance, 1997), as a system that is deeply rooted in White supremacy and foundational to perpetuating health inequities. Despite increased scholarship around the public health harms of the carceral system and calls for abolition of the PIC as a public health strategy (American Public Health Association [APHA], 2020), public health training in the United States (U.S.) does not include a comprehensive examination of the PIC, its public health impacts, or the field’s complicity in the PIC.

We, the authors of this commentary, are current and former public health students across various U.S. universities who recognize that health equity cannot be advanced until our field actively and explicitly resists the PIC. We believe public health training needs to utilize disciplinary self-critique, a tenet of public health critical race praxis (PHCRP), to highlight how public health training norms reproduce injustices within public health and society at large (Ford & Airhihenbuwa, 2010; Hardeman & Karbeah, 2020). PHCRP applies principles from critical race theory to address the ways racism influences health inequities and the approaches used to study them (Ford & Airhihenbuwa, 2010). Guided by PHCRP, we outline the historical and contemporary public health harms of the PIC, the gaps in current public health training, and our collective vision for a public health education grounded in abolitionist theory and practice.

The History and Growth of the PIC

An examination of the PIC must begin with the history of policing and incarceration as systems of the carceral state built to protect racial capitalism and White supremacy while subjugating Black, Indigenous, migrant, and other marginalized communities. Racial capitalism describes the modern world system that combines racialized exploitation with capital accumulation; depends on slavery, colonialism, and genocide (Robinson, 1983); and is increasingly being interrogated as a fundamental cause of health inequities (Laster Pirtle, 2020; McClure et al., 2020). The maintenance of racial capitalism is woven into the fabric of policing from its origins in the 18th century of slave patrols that squashed uprisings of enslaved people and captured people seeking freedom (Reichel, 1992). Over time, slave patrols transformed into militia-style policing units in charge of enforcing the “Black Codes,” which regulated and restricted Black people’s ability to work, vote, own land, and live (Hassett-Walker, 2021). This was the first glimpse into the PIC as new models were created to uphold racialized hierarchies, such as the first prison boom and the proliferation of prison labor camps (Alexander, 2010). It also established social constructions of “crime” and who is deemed a criminal, effectively reproducing both anti-Black racism and classism (Muhammad, 2011, p. 79).

In later years, policing and incarceration adapted to the changing political and social climate to continue the maintenance of White supremacy. The ratification of the Fourteenth Amendment, which granted all citizens (including formerly enslaved people) equal protection under the law, was quickly followed by Jim Crow laws that legalized racial segregation (Hassett-Walker, 2021). Police were key enforcers of these laws and actively undermined the Civil Rights Movement, its leaders, and supporters through surveillance and statesanctioned violence (United States. Congress. Senate Select Committee to Study Governmental Operations with Respect to Intelligence Activities, 1976). Beginning in the 1970s, the “War on Drugs” marked another rapid expansion of both police and prisons with a tripling of drug-related arrests between 1980 and 1993 (Tonry, 1994, p. 70).

Today, the United States has the highest incarceration rate in the world (Sawyer & Wagner, 2022). There are 2 million people currently incarcerated in the U.S., representing a 500% increase over the past four decades (The Sentencing Project, 2022). While home to less than 5% of the global population, the U.S. holds nearly 16% of the global incarcerated population (Vera Institute of Justice, 2022). Beyond these staggering absolute numbers, the racialized disparities of policing and incarceration are striking. Black men comprise only 13% of the population but 35% of those incarcerated, equivalent to an incarceration rate 3.6 times higher for Black people than White people (Hinton et al., 2018). Furthermore, people racialized as Black, Indigenous, Latinx, and Pacific Islander are disproportionately surveilled, stopped, and killed by police (Edwards et al., 2018; Gelman et al., 2007; Hyland et al., 2015; Kramer & Remster, 2018; Schwartz & Jahn, 2022).

The prominence of the PIC directly reflects the utilization of punitive strategies as a method of social control (Deivanayagam et al., 2021). More than 80% of all arrests are for low-level, nonviolent offenses related to poverty (Vera Institute of Justice, 2022). Carceral responses do not meet the needs of historically and structurally marginalized communities. Instead, these responses reproduce poverty, racism, and political disenfranchisement—the same factors that cause many people to turn to criminalized behaviors as a means of survival in the first place (Jahn, 2020).

Public Health and the PIC

Public health institutions, both academic and professional, perpetuate this cycle of criminalization by relying on the criminal legal system to address public health issues. This complicity has been referred to as the “carceral management of poverty” and includes relying on law enforcement to address gun violence, homelessness, substance use, and mental health crises (Wacquant, 1999, p. 349); engaging in surveillance, mandatory reporting, and family separation via the child welfare or “family policing” system (Roberts, 2022, p. 160); using criminalization and punishment via police to enforce COVID-19 mandates (Kajeepeta et al., 2022); sharing the results of drug, HIV, and other tests with law enforcement; and employing armed police in public health hospitals (Beyond Do No Harm, n.d.; Towards Abolition, n.d.). Beyond these harms, public health contributes to the nonprofit industrial complex that focuses on individual behavioral change rather than root causes of harm; reforms carceral systems rather than implementing noncarceral solutions; and provides short-term support for individuals rather than long-term structural changes (Davis et al., 2022).

Utilizing carceral responses as the predominant strategy for addressing public health issues has itself led to a public health crisis (Jahn, 2020). Much research demonstrates the health harms of involvement with the criminal legal system on individuals, families, and communities (APHA, 2020). The collateral damage of the PIC as a public health solution begs the question: who is actually included in the term “public”?

The extensive harms of the PIC are rarely, if ever, discussed within public health curricula (Rice, 2022). Current public health training paradigms have shifted away from the mid-19th century model that was rooted in progressive structural changes such as housing, economic, sanitation, and workplace reforms (Fairchild et al., 2010). Instead, our training often perpetuates healthism, the idea that an individual’s health and wellbeing lies solely in their personal responsibility (Crawford, 1980). Contemporary complex public health crises such as COVID-19, climate change, gun violence, abortion criminalization, voting restrictions, and anti-queer and trans violence all require multifaceted and structural strategies that address the mechanisms that (re)create the social, structural, political, and commercial determinants of health (Breilh & Krieger, 2021). Unfortunately, public health education is simply not teaching the content and skills necessary to facilitate these responses (Brownson et al., 2017). Instead, most public health research and training focuses on the proximate causes of disease, biology, individual behavior change, and medical solutions, with little emphasis on the sociopolitical roots of health inequities (Fleming et al., 2022). For example, the initial public health response to HIV identified social identities as risk factors (e.g., the CDC referring to the “Four Hs—homosexuals, heroin users, hemophiliacs, and Haitians”) rather than structural risk factors such as lack of housing and employment, or criminalization of homosexuality, sex work, and drug use (Alang & Blackstock, 2022). Similarly, the national COVID-19 response heavily focuses on individual behaviors and pharmaceutical interventions (e.g., vaccines, individual decisions on masks) rather than structural changes such as universal health care and paid sick leave.

Furthermore, the lack of public health education that is informed by social, political, and historical theory and praxis is a testament to the atheoretical paradigm that has long sustained the harms enacted by the field of public health (Petteway, 2023). When we are taught that the functions of public health are separate from our sociopolitical realities, we risk entrapping ourselves into a disembodied epistemology that separates not only knowledge from its context but also the learners from each other in their processes of knowing. We name this function as carceral.

Abolition of the PIC

Abolition is a political vision and a practical organizing tool for eliminating prisons, policing and surveillance that (re)create harm while building life-affirming institutions and lasting alternatives to punishment (Critical Resistance, 1997). Abolition of the PIC ultimately creates a world where people have what they need to live healthy and safe lives in their communities. As abolitionist scholar Dr. Ruth Wilson Gilmore states, abolition is a positive project about presence, not absence (Lambert, 2019). While many assume abolition is solely about dismantling, it is also about re-envisioning and co-creating a world where everyone’s needs are met and where harm is addressed without relying on structural forms of oppression (Davis et al., 2022; Kaba, 2021). It is about “abolishing the conditions under which prison became the solution to problems, rather than abolishing the buildings we call prisons” (Gilmore & Murakawa, 2020, 12:52).

Public Health and Abolition

Public health training must move beyond reductionist and deficit-focused models toward teaching actionable knowledge and skills grounded in strengths-based approaches that address root causes of inequity (Champine et al., 2022). As such, we propose abolition as a public health strategy and encourage training that better equips future generations of public health practitioners to truly promote the health of all people. Abolitionist public health approaches strongly align with primary prevention, a concept well known to all public health students, defined as the prevention of disease before onset, the promotion of optimal health and wellbeing, and the provision of access to resources needed to thrive (APHA, 2020).

These ideas are not novel. We can look to history to learn the ways communities have used abolitionist public health approaches to collectively mobilize and care for each other while simultaneously resisting oppressive systems. For example, the Black Panther Party opened free health clinics across the country (Nelson, 2013), implemented a free breakfast program that sought to break the connection between intergenerational hunger and economic marginalization by feeding children nationwide (Potorti, 2017), and started a national sickle cell anemia screening program (Bassett, 2016). Similarly, the Young Lords, a Puerto Rican activist organization, drew attention to health inequities and poverty by working with medical providers to offer door-to-door education and screening for poisoning and tuberculosis in New York and demanded better health care and improved conditions through direct action (Fernández, 2020). These historical health activism and abolitionist public health efforts highlight another important tenet of abolition generally lacking in current public health education: the importance of community. It is not enough to acknowledge the harms of the system, it is also necessary to actively work to undo the harms by engaging with, centering the priorities of, and creating space to be led by communities marginalized by systems of oppression, in both research and praxis (Fleming et al., 2022).

As students of public health, we see the urgency to include abolition in our curricula, and dually, we see the dangers of co-optation. Academia has long appropriated the radical history of terms associated with social and political movements. This erasure of political roots is an act of depoliticization, where meaning is removed from language to advance profit, capital, or maintain a social order. As students in academia, we have witnessed committees and task forces adopt “radical” language, claim to do the work of equity, all while draining student and staff volunteers of their time and resources, with no structural change ultimately produced. Diversity, Equity, and Inclusion has become an industrial complex in itself—a machine motivated by profit, capital, and the maintenance of academic hierarchy (Lett et al., 2022). With this said, we do not wish to feed abolition to this machine. Our desire is to pursue abolition through education as a means of liberation—not academia as liberation.

In the current crisis of trust in public health (The Commonwealth Fund, 2022), there is a dire need to transform the public health curriculum to reshape the future of the field. A shift in curriculum also has larger implications for the broader struggle of abolition when the field of public health and academia at large recognize that education contributes to life as a whole, rather than simply operating within a vacuum. Abolition in our curriculum is how we harvest the classroom as a place of critical pedagogical growth, and, as Black feminist bell hooks (1994) names, re-envision the classroom as the most radical space of possibility in the academy.

Beyond addressing the deleterious impacts of the PIC on public health, a public health abolitionist training encourages an upstream, community-led focus that centers the margins (Ford & Airhihenbuwa, 2010) and examines the underlying causes of disease that move beyond the social determinants of health (SDOH). While there is growing focus on the SDOH, it is crucial to interrogate the sociopolitical forces, such as racial capitalism (Laster Pirtle, 2020), that underlie and create those social determinants. Indeed, many public health foundational principles (e.g., 10 Essential Public Health Services) can be used to build life-affirming structures and reduce the scope and scale of the PIC through primary prevention strategies, such as affordable housing and economic security (Human Impact Partners, 2022).

Current pedagogical examples of interrogating structural racism, including the PIC, are limited (Chandler et al., 2022; Rice, 2022). However, there are some examples of public health faculty who teach courses related to the public health impacts of criminalization and mass incarceration (Duarte et al., 2020; Fullilove et al., 2020; Heller & Galea, 2020; Nowotny et al., 2020; Rice, 2022) as well as efforts in social work (James, 2021) and medicine (Asmerom et al., 2022) that integrate abolition into the curriculum. Echoing other recent calls, there is a need for academic public health to generate scholarship and train professionals on the population health consequences of the PIC and develop community-led strategies to reduce incarceration (Heller & Galea, 2020). Faculty can utilize the rich body of literature developed outside of academia for teaching and discussing abolition (Kaba, 2021; Kaba & Ritchie, 2022; Towards Abolition, n.d.), and academic institutions can pay local abolitionist community organizers and leaders to bring their lived experiences, expertise, and knowledge to the classroom.

Call to Action and Invitation

We are neither the first nor will we be the last to call for public health training to address the harms of the PIC (APHA, 2020). We hope this call to action can be a catalyst for the field to join the growing coalition of people across identities, geographies, and politics working toward true public health and safety that does not involve policing or punishment. To pursue this, One Million Experiments (2022) helps guide the creativity, imagination, and experimentation necessary to create a world in which everyone can thrive. This means abolitionist public health can be pursued in a myriad of ways from the interpersonal to the systemic level. For example, we can integrate the public health consequences of the PIC into the curriculum (Heller & Galea, 2020); organize alongside existing studentled efforts such as the national abolitionist Cops off Campus Coalition (2022); contribute to public health education for those who are incarcerated (Fullilove et al., 2020); join local mutual aid efforts (Spade, 2020); examine the health inequities in the carceral system that have been illuminated by the COVID-19 pandemic to advocate for decarceration at local prison and jails (Beckett et al., 2021); and organize and build power with students (Little, 2020) and faculty (University of Michigan School of Public Health Faculty, 2020) to demand university’s investment in policing be redirected to mental health services, affordable housing, adequate pay, and other factors that create more equitable and just campuses. While we do not expect academic spaces to be a sole source of abolition, we see it as a site of struggle, collaboration, and learning on the way toward abolition. Grounded in this spirit of experimentation and imagination, the following includes additional invitations, ideas, and examples of actions for individuals, faculty, and public health programs to bring abolition into their lives and public health work.

Individuals

• Practice reflexivity. Abolition requires continual unlearning and relearning. Reflexivity allows us to authentically engage in the processes of unlearning harmful ideas and actions and relearning caring ideas and actions to take their place (Ford & Airhihenbuwa, 2010). This practice is ongoing, but never linear or static.

• Actively build and organize with community. As Kaba (2021) tells us, “everything worthwhile is done with other people.” Whether that be grounded in learning, organizing to end carceral practices and policies at your university and/or city, or simply fostering caring relationships with one another, we encourage individuals to begin to co-conspire and build a coalition in community, both in and outside of academia.

• Resist disposability. A carceral framework presupposes that certain populations, particularly those that have been “othered,” are disposable. Disposability is a carceral solution to harm and conflict, but abolition means that no one is disposable. When we experience small instances of harm in our daily lives, rather than ignore or dispose, we must practice addressing these harms to prevent them from becoming larger and to build our collective capacity for transformative justice.

• Leverage existing public health training for abolitionist goals. Those who have studied public health receive comprehensive training on implementing and evaluating interventions. With a cautious eye to co-optation and the harms of the nonprofit industrial complex that public health contributes to, we can leverage our existing public health skills in evaluation and qualitative research to contribute to noncarceral, preventive, community-based responses that address harm and foster accountability.

Professors and Teaching Faculty

• Reject the myth of objectivity. Instructors of public health must reject the atheoretical history of public health and the idea that science can be objective or apolitical. Through embracing critical pedagogy and understanding that all research is influenced by researchers’ social, historical, and political contexts, students and instructors alike will be able to collectively embrace bridging theory to practice (Figure 1).

• Embrace abolition as pedagogy. Abolition is both content and practice. It is not enough to simply offer abolitionist subject matter—it is also a pedagogical framing to how subject matter is taught. For example, instructors can create caring and restorative classroom environments as opposed to ones based on punishment (Love, 2019).

• Be a champion. Academic environments inhibit work toward liberation through punitive measures against those who speak out. Professors, especially those who are tenured, can be advocates for racial justice, critical pedagogy, and abolitionist frameworks, in support of students, faculty who are not tenured, and community partners, and must be prepared to embrace the consequences that come with it.

• Be a disruptor. Academia thrives on complicity. Do not be afraid to upset the status quo. Start to practice identifying power dynamics (including your own power) and then begin disrupting them.

• Name structural oppressions. Faculty must upend the assumption that students receive foundational knowledge about structural racism elsewhere. Instead of skirting around the topic, address it head on with a critical pedagogical stance. Instead of dismissing classroom tensions by being silent on topics such as structural racism, lean into the discomfort and provide an inclusive environment to unlearn and relearn together. An abolitionist ethos understands that mistakes will be made and that collective efforts of creating accountability—without disposability or punishment—will move us toward justice.

Figure 1.

Proposed Transformations of Public Health Training.

Public Health Programs

• Revise curriculum. In core classes, include learning objectives about the public health harms of the PIC. Ensure that abolitionist concepts and pedagogy are integrated at all levels, particularly as part of the foundational teachings of public health. Furthermore, core disciplines of public health should identify unique aspects of how policing, incarceration, and abolition can integrate into their specific curricular focus (e.g., epidemiological approaches to measuring the population health harms of policing or environmental health frameworks that incorporate the interconnectedness of climate change and mass incarceration [Prins & Story, 2020]). This should include paid input or guest lectures from local organizers and people who have directly experienced the harms of policing and incarceration.

• Experiment and evaluate. Evaluation, when used as a tool for critical inquiry and exploration, can help build a more transformative educational institution. Ongoing evaluation efforts can support the process of experimentation—whether it may be piloting new curriculum or instructional methods—and can also embody an abolitionist praxis.

• Amplify student and community voices. Center student and community voices, especially the voices of abolitionists who are directly impacted by the criminal legal system, in all aspects of program planning, from design to implementation. Seek to host active, ongoing dialogue that empowers students to be a part of curriculum shifts toward abolition.

• Speak up and speak out. As powerful and respected authorities, leadership of public health programs must use their platform to draw attention to the ways that the PIC harms health, including the deadly impact of COVID-19 spreading unabated in prisons and jails and the ongoing disproportionate police killings of Black and Brown people. To address these harms, leaders must draw on the growing body of evidence that explicitly names abolition as a public health strategy (APHA, 2020).

• Examine institutional complicity. Many university endowments are invested in companies that exploit and benefit from the PIC. Universities also purchase furniture or other products made by people who are incarcerated and not adequately paid for their work, if paid at all. Administrators and department heads in academic institutions have power to challenge these unjust practices that are antithetical to their stated public health goals.

As an assembly of emerging public health students, we invite other public health students to build with us. We believe education to be a catalyst for liberation and a site of abolitionist learning and practice. While the academy is not liberation itself, academia is where many public health leaders receive their training. Because of this, we feel strongly that public health students can find unity in our efforts toward an abolitionist future. We invite readers to contact us so that we may collectively continue to build momentum in pursuit of a more just future.